CwC - Ep. 21 - Q&A Episode – December 2018

Jessica Combs joins Mark to in a Q&A style discussion to address recent questions on healthcare trends. Mark addresses each question on various topics including private equity interest in healthcare, the opioid crisis, neutral site payments, healthcare technology, and revenue cycle management.

Questions

We have heard much discussion in the media and throughout this election season on the opioid crisis, but I’m curious if this is something of a significant impact yet on physicians and medical groups or hospitals. Have you observed any specific instances where the talk in the media and Washington has resulted in major changes – positive or negative – for healthcare entities?  We have been monitoring the issue of “neutral site payments” all year, as this could have a significant impact on hospital payments for those entities that have spent a lot of time and dollars investing in outpatient services. Can you comment on what has happened with this matter and perhaps make any predictions for how the results of the midterm elections could influence the outcome on this issue? In listening to your episode on what hospital boards should be thinking about concerning healthcare technology, we have been paying a lot of attention to the frequent stories that emerge about fines and legal issues (not to mention PR concerns) that many hospitals are dealing with in protecting records, maintaining security in the information systems, and lacking appropriate documentation. However, there are so many facets of protecting data that an organization like a hospital – even a relatively small, rural community hospital – must consider that it’s challenging to think about where to start. How would you suggest a leadership team begin to confront this issue to ensure we have as much protection as possible from some of those risks? Our organization has been struggling from revenue stagnation (and even drops in some cases) that we know are not tied to negative changes in payer contracts, fee schedule changes, expense management, or even the billing and collections component of the revenue cycle. So, we think the issue could be related to coding; however, in the past, our focus on coding has mainly been to ensure our providers are not up-coding. How could coding issues play into the broader revenue cycle management procedures? As it has become commonplace to see hospitals buying physician groups, some local markets have seen significant shifts as a result of larger groups selling to hospitals. Meanwhile, new players, such as large corporate systems or groups backed by private equity investors are entering markets and competing with the hospitals for acquiring major physician groups, which can significantly shake up the dynamic between the physicians within those groups and the hospitals they interact with on a regular basis at a local level. My question is twofold: 1) Have you seen this take place; and, 2) how might this trend potentially shake up local healthcare markets more in the future? Can hospitals compete with outside players that bring significant financial resources to invest in such deals? 

Extras

The Next Stage of Evolution in Physician Practice Transactions

Coffee with Coker Episode 17: Executives Beware: Five Questions Astute Boards are Asking about Healthcare IT

Follow Mark on Twitter

Connect with Mark on LinkedIn

Connect with Jessica on LinkedIn

 

Join us on January 24, 2019, at 2:00 pm for the live panel discussion One Month into MACRA!

As part of the Medicare Access and CHIP Reauthorization Act (MACRA), the Medicare Quality Payment Program (QPP) was established and consists of two participation pathways for clinicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). CMS has been gradually implementing the full scope of MACRA over the past three years, and January 1, 2019, marks the beginning of MIPS adjustments to Medicare Part B fee-for-service revenue. The panel discussion will focus on identifying potential pain points for healthcare organizations as a result of MACRA and review key changes for CY 2019 as outlined in the final rule.

Learning Objectives

Identify the potential pain points of full MACRA implementation and outline the first steps organizations should take to alleviate issues. Review the final rule for the quality payment program and how these changes impact APMs and MIPS. Discuss the impact E/M changes will have on reimbursement and physician compensation.

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